Provider Demographics
NPI:1457520785
Name:FERGUSON, JENNIFER LEE (CADC, LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CADC, LSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 SOUTH 4TH STREET
Mailing Address - Street 2:PAWPRINT PATHWAY COUNSELING, PLLC
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462
Mailing Address - Country:US
Mailing Address - Phone:309-734-2813
Mailing Address - Fax:
Practice Address - Street 1:1122 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-2734
Practice Address - Country:US
Practice Address - Phone:309-734-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26742101YA0400X
MN349611041C0700X
IA0078311041C0700X
IL149.0178851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)